768 resultados para critically ill


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Abstract Maintaining the health of a construction project can help to achieve the desired outcomes of the project. An analogy is drawn to the medical process of a human health check where it is possible to broadly diagnose health in terms of a number of key areas such as blood pressure or cholesterol level. Similarly it appears possible to diagnose the current health of a construction project in terms of a number of Critical Success Factors (CSFs) and key performance indicators (KPIs). The medical analogy continues into the detailed investigation phase where a number of contributing factors are evaluated to identify possible causes of ill health and through the identification of potential remedies to return the project to the desired level of health. This paper presents the development of a model that diagnoses the immediate health of a construction project, investigates the factors which appear to be causing the ill health and proposes a remedy to return the project to good health. The proposed model uses the well-established continuous improvement management model (Deming, 1986) to adapt the process of human physical health checking to construction project health.

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Through media such as newspapers, letterbox flyers, corporate brochures and television we are regularly confronted with descriptions for conventional (bricks 'n' mortar style) services. These representations vary in the terminology utilised, the depth of the description, the aspects of the service that are characterised and their applicability to candidate service requestors. Existing service catalogues (such as the Yellow Pages) provide little relief for service requestors from the burdensome task of discovering, comparing and substituting services. Add to this environment the rapidly evolving area of web services with its associated surfeit of standards, and the result is a considerably fragmented approach to the description of services. It leaves the reality of the Semantic Web somewhat clouded. --------- Let's consider service description briefly, before discussing our concerns with existing approaches to description. The act of describing is performed prior to advertising. This simple fact provides an interesting paradox as services cannot be described exactly before advertisement. This doesn't mean they can't be described comprehensively. By "exactly", we are referring to the fact that context provided by a service requestor (and their service needs) will alter the description of the service that is presented to the discoverer. For example, a service provider who operates a cinema wants to describe the price of their service. Let's say the advertised price is $15. They also want to state that a pensioner discount and a student discount is available which provides a 50% discount. A customer (i.e. service requestor) uses the cinema web site to purchase tickets online. They find the movie of their choice at a time that suits. However, its not until some context is provided by the requestor that the exact price is determined. The requestor might state that they are a pensioner. The same is applicable for a service requestor who purchases multiple tickets perhaps on behalf of other people. The disconnect between when the service is described and when a requestor provides context introduces challenges to the description process. A service provider would be ill-advised to offer independent descriptions that represent all the permutations possible for a single service. The descriptive effort would be prohibitive.

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Why Fundamentalism? was an exhibition proposal and critical writing project developed from concept phase through to detailed proposal. It included an edited video document that lay out its core ideas and presented the diverse voices of each collaborator. A number of key themes were engaged around the hot-button (and much misunderstood) concept of Fundamentalism. The proposal included an exhibition layout, developed test imagery, ideas and animations, proposed forms for future works and a process whereby design briefs would lead to subsequent commissions. Two major grant applications were submitted to the Australia Council and Arts Queensland, with the support of State Library of Queensland, the University of Adelaide and numerous others. The project remains at the developed proposal stage awaiting suitable funding----- Critically the show became an active vehicle for drawing and exploring a line of distinction between ideas of ‘what is fundamental’ and ‘fundamentalism’ as it rested in the popular imagination, as well as in political and philosophical debates. It teased out and engaged with a number of key questions that included The Problem of Ungroundedness, A Politics of Finitude, The Post-modern/Pluralist Problem, Silent Fundamentalisms (Voices of Reason and Neo-con Religions), Fundamentalism as a Media Construct, The Pre and Post Cold-war Other, The Pressing Need for Foundations in the West and Islam as Foundationalism (rather than fundamentalism).

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Aim: To review the titles, roles and scope of practice of Advanced Practice Nurses internationally.----- Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context.----- Method: CINAHL, Medline, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant.----- Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles.----- Conclusion: Advanced Practice Nurses are critical for the future, provide cost-effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.

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Developing an effective impact evaluation framework, managing and conducting rigorous impact evaluations, and developing a strong research and evaluation culture within development communication organisations presents many challenges. This is especially so when both the community and organisational context is continually changing and the outcomes of programs are complex and difficult to clearly identify.----- This paper presents a case study from a research project being conducted from 2007-2010 that aims to address these challenges and issues, entitled Assessing Communication for Social Change: A New Agenda in Impact Assessment. Building on previous development communication projects which used ethnographic action research, this project is developing, trailing and rigorously evaluating a participatory impact assessment methodology for assessing the social change impacts of community radio programs in Nepal. This project is a collaboration between Equal Access – Nepal (EAN), Equal Access – International, local stakeholders and listeners, a network of trained community researchers, and a research team from two Australian universities. A key element of the project is the establishment of an organisational culture within EAN that values and supports the impact assessment process being developed, which is based on continuous action learning and improvement. The paper describes the situation related to monitoring and evaluation (M&E) and impact assessment before the project began, in which EAN was often reliant on time-bound studies and ‘success stories’ derived from listener letters and feedback. We then outline the various strategies used in an effort to develop stronger and more effective impact assessment and M&E systems, and the gradual changes that have occurred to date. These changes include a greater understanding of the value of adopting a participatory, holistic, evidence-based approach to impact assessment. We also critically review the many challenges experienced in this process, including:----- • Tension between the pressure from donors to ‘prove’ impacts and the adoption of a bottom-up, participatory approach based on ‘improving’ programs in ways that meet community needs and aspirations.----- • Resistance from the content teams to changing their existing M&E practices and to the perceived complexity of the approach.----- • Lack of meaningful connection between the M&E and content teams.----- • Human resource problems and lack of capacity in analysing qualitative data and reporting results.----- • The contextual challenges, including extreme poverty, wide cultural and linguistic diversity, poor transport and communications infrastructure, and political instability.----- • A general lack of acceptance of the importance of evaluation within Nepal due to accepting everything as fate or ‘natural’ rather than requiring investigation into a problem.

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Participatory evaluation and participatory action research (PAR) are increasingly used in community-based programs and initiatives and there is a growing acknowledgement of their value. These methodologies focus more on knowledge generated and constructed through lived experience than through social science (Vanderplaat 1995). The scientific ideal of objectivity is usually rejected in favour of a holistic approach that acknowledges and takes into account the diverse perspectives, values and interpretations of participants and evaluation professionals. However, evaluation rigour need not be lost in this approach. Increasing the rigour and trustworthiness of participatory evaluations and PAR increases the likelihood that results are seen as credible and are used to continually improve programs and policies.----- Drawing on learnings and critical reflections about the use of feminist and participatory forms of evaluation and PAR over a 10-year period, significant sources of rigour identified include:----- • participation and communication methods that develop relations of mutual trust and open communication----- • using multiple theories and methodologies, multiple sources of data, and multiple methods of data collection----- • ongoing meta-evaluation and critical reflection----- • critically assessing the intended and unintended impacts of evaluations, using relevant theoretical models----- • using rigorous data analysis and reporting processes----- • participant reviews of evaluation case studies, impact assessments and reports.